Inspection on 14/09/05 for Tutnall Hall Nursing Home

This inspection was carried out on 14th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Tutnall Hall Nursing Home 06/11/06

Tutnall Hall Nursing Home 24/04/06

Tutnall Hall Nursing Home 20/02/06

Tutnall Hall Nursing Home 20/03/05

Tutnall Hall Nursing Home 12/07/04

Tutnall Hall Nursing Home 06/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

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Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Tutnall Hall Nursing Home Tutnall Bromsgrove Worcestershire B61 1NA Lead Inspector Mandy Burton Unannounced 14 September 2005 11:35 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Tutnall Hall Nursing Home Address Tutnall, Bromsgrove, Worcestershire B61 1NA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01527875854 Alpha Health Care Limited Care Home with Nursing 40 Category(ies) of DE(E) Dementia over 65 (3) registration, with number OP Old age (40) of places PD(E) Physical disability over 65 (40) Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20 March 2005 Brief Description of the Service: Tutnall Hall is situated in a quiet rural position, between Bromsgrove and Redditch, and is part of Alpha Healthcare Limited, a company that operates a number of care homes for older people several of which are within Worcestershire. The home is registered to provide nursing care and accomodation for a maximum of 40 residents over the age of 65 years. As part of this registration the home can also accommodate up to 3 older people with a dementia related illness. A trained nurse is on duty in the home at all times. Accommodation is provided on three floors that are accessed via a passenger lift or two staircases located on either side of the building. There are a total of 19 single bedrooms, 16 of which have ensuite facilities and 10 shared rooms of which 6 have ensuite facilities. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and started at 11.35am. The inspection was undertaken by two inspectors and took place over a period of 5 hours. The main focus of this inspection was to assess care practice and to review progress made by the home to address requirements made at the previous inspection on 20.03.05. A brief tour of the home took place and a selection of care and staff records were examined. Three residents six visitors and four members of staff were spoken to during the course of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Improvements are needed to the assessment process to ensure the emotional and social needs of residents are taken into consideration prior to their admission and to ensure appropriate support is identified. Better recording systems are needed for residents with high dependency needs in respect of fluid intake/ output, oral care and pressure relief. A more robust system for wound care management will ensure consistency of practice and a more effective evaluation of treatment . Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 5. While staff in this home have a very good understanding of the individual needs of residents in their care, shortfalls in the assessment process mean that the social and emotional needs of residents may not always be identified and supported. The home welcomes prospective residents and their representatives to visit the home prior to making a decision to move into the home. EVIDENCE: All residents are assessed by a trained nurse prior to their admission to the home. Written records are kept of all assessments. Files for a recently admitted resident were examined. An assessment had been undertaken. Records seen contained basic information about the physical needs of the resident concerned, with insufficient information about the resident’s emotional and social needs. There was very limited space on the form to record information in any detail. Due to the general poor health of residents being admitted to the home residents do not often visit prior to their admission. On the day of this inspection the manager was showing a number of relatives around the home Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 9 with a view to future placements for their family member. The manager was observed spending time with each visitor finding out more about the needs of the individual and discussing how these needs could be met if they moved into the home. In addition to this visitors were given a full tour of the home and information about how the home is run. Visitors viewing the home spoke positively of their ‘first impressions’ of the home and the kindness showed to them by the manager. Staff in the home have a good understanding of the needs of each resident in their care and were observed to be caring for residents in a caring and sensitive manner. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. Staff in this home continue to make good progress to improve arrangements to ensure the health care needs of residents are identified and met. There is however no evidence that residents’ emotional and social needs are being supported. Systems for the administration of medication are good and ensure residents’ medication needs are met. Personal support is offered in a way, which promotes the privacy and dignity of each resident. EVIDENCE: Written care plans are in place for each resident. It is clear from records seen that staff in the home have become more confident in the care planning process and the quality of documentation continues to improve. A selection of care plans was examined. Plans seen referred primarily to the physical and health care needs of each person. Discussions with staff indicated that they had developed good relationships with residents and had a good understanding of their social and emotional needs. This was not however supported in care plans, which made no reference to the social and emotional needs of residents and how these were being supported by staff. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 11 Since the last inspection staff in the home have tried to encourage residents or their representatives to become more involved in the care planning process asking them to sign to agreed each plan of care. There was evidence that plans were being reviewed on a regular basis Several residents in the home had wounds. Records seen in relation to these wounds indicated that a more concise wound care management system is necessary which details the condition/status of each wound the current treatment and intervention. Information about wound care was in place on the file although it was difficult to see how the care was being provided as the information was kept in separate places and was difficult to track. It was noted that photographs of wounds had been taken on a number of occasions in order to evaluate the effectiveness of treatment being given. There was also evidence that staff had sought the specialist advice of the tissue visibility nurse when necessary. Better recording systems are needed for residents with high dependency needs. Several residents with high dependency needs were being cared for in bed. Records kept in relation to the ongoing care provided to these residents was inadequate and led the reader to believe residents had not received any personal care or had pressure relief for long periods and were not being offered sufficient fluids and oral hygiene. Observations made and discussions with staff indicated that this was not in fact the case. Risk assessments were in place for moving and handling, nutrition and skin care. The majority of the risk assessments seen were regularly reviewed and updated although on one plan the moving and handling risk assessment had not been reviewed for three months. It was also noted that a moving and handling assessment for one resident was not completed until 4 days after their admission. Records of medical practitioners visits to the home were kept and the primary healthcare team were consulted regularly. The management of medication in the home is good. A random selection of medication administration records were examined and an audit carried out. Records were in good order and appropriate safeguards were in place. Appropriate systems were in place for the receipt, storage and disposal of medication. Observations made during the inspection indicated that the staff treated residents with respect. Residents and visitors who were spoken to confirmed that staff were respectful and knocked on doors before entering. Relationships between residents and staff were seen to be warm and affectionate. One resident said, “I am very pleased with the way I am treated”. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 12 A visitor said that they thought their relative was “very well cared for and said, “The girls are good”. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 Limited social and recreational opportunities are currently available to residents living in this home and there is little evidence that those available meet the needs and expectations of the residents. EVIDENCE: An activities co-ordinator has recently been appointed but has not yet started in the home. The manager stated that when the co-ordinator starts they would spend time with individual residents finding out their interests so that the activities program will be meaningful to them. There were few activities on offer at the time of inspection. Visitors and residents who were spoken to commented on the lack of activities available. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not inspected. EVIDENCE: Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26. The general standard of the environment within this home is good and provides residents with a clean, comfortable and homely place to live in. Some maintenance work is however necessary to ensure residents’ right to privacy is respected and that they are kept safe. EVIDENCE: A brief tour of the buildings was undertaken and the newer part of the building was seen to be well maintained and decorated. The carpet in one bedroom doorway was frayed and coming away from the carpet gripper. Locks on some doors were not of the recommended type for fire safety purposes. These were removed during the inspection. The glass in the conservatories did not have a kite mark to confirm that it was safety glass. There were some concerns about the older part of the building in terms of general wear and tear and weather damage. In particular the wooden window frames were seen to be deteriorating. The doors to the ensuite facilities in two bedrooms in the older part of the building were noted to have no privacy locks fitted and one bathroom door was noted to have no privacy lock nor would the door close properly. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 16 Two fire exits onto the fire escape stairwell did not have any alarm fitted to indicate if they were opened. The fire door did not close onto it’s rebate on bedroom number 2. An immediate requirement was issued in relation to this. The laundry room is separate from the main building and laundry was transported around the home in appropriate coloured bags. The laundry room floor was in need of sealing and the walls needed filling in, in places and repainting. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. The home is generally appropriately staffed. Residents are however potentially at risk when the home fails to provide adequate agency cover in the event of staffing shortfalls. Residents are protected by the home’s recruitment procedure and practice. EVIDENCE: On the morning of this inspection 33 residents were living in the home and the home was adequately staffed to meet the needs of those residents. The atmosphere within the home was very relaxed and staff were observed carrying out their duties in a very unhurried manner. A trained nurse is on duty in the home at all times. A staffing rota was displayed which detailed the staff on duty twenty-four hours a day. Discussion with some staff highlighted that any staffing shortfalls are typically covered by accessing agency staff. Problems do however reportedly arise when agency staff are due to replace staff working 7.30 am - 2.30pm but in fact only work 9am-1pm leaving fewer staff to assist residents at key times. Since the last inspection the home has successfully recruited catering staff for evening duties. Records relating to one member of staff were seen which demonstrated that appropriate checks were carried out prior to them commencing employment at the home. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35 and 38. The home is well managed and staff provided with the support and guidance to care for the individual needs of residents. Appropriate systems are generally in place to ensure residents are kept safe but current shortfalls in fire safety measures are compromising this situation and placing residents at risk EVIDENCE: Since the last inspection the former ‘acting manager’ has taken up the position of home manager and an application for registration with the Commission For Social Care Inspection was being processed. The home manger is a registered nurse with many years experience in the care of older people. It was evident from this inspection that the manager is committed to improving practice whenever necessary and seeks to ensure residents in her care receive good care. There are good relationships between the manager and her deputy, both of whom make themselves open and accessible to all members of the staff team. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 19 Staff spoken to were complimentary of both the manager and deputy and said that they felt supported by them. The records relating to the personal monies held for safekeeping were seen. Individual records are kept and monies held securely. A sample of accounts were audited and noted to be in good order. Discussions took place about a two week delay in a key worker returning monies after purchasing toiletries on behalf of a resident. It was recommended that the home consider introducing monthly account audits as a form of good practice and to provide additional safeguards for residents. The home’s insurance certificate on display noted that cover had expired on 6th May 2005. The manager reported that a new certificate had been received but was not on display as yet. Fire safety checks were signed as being undertaken at the required frequency. There was no certificate in place to show that the fire alarm system was up to the L1 standard. Records are kept of all accidents that occur. Records seen showed that staff had taken appropriate action at the time of the event. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 3 x x 3 x x 2 Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3, 7 Regulation 12(1) 14 15(1) Requirement Written assessments must include details of the social and emotional needs of each resident. Care plans must be documented whenever needs are identified which detail the specific care and support required to meet these needs. A written programme of wound care management must be developed and implemented which includes systems for the assessment of wounds and individual plans which include details of the status, size and current treatment of each wound. Moving and handling assessments must be undertaken and recorded for each resident on their admission to the home. Assessments must be reviewed at least once a month. Records must be kept which accurately evidence the care being given to residents with high dependancy needs. A planned programme of social and recreational opportunities should be made available to Timescale for action Immediate and ongoing 2. 8 12(1) 15 1st November 2005 3. 8 13(5) Immediate and ongoing 4. 8 12(1) 15(1) 12(1) 16 Immediate and ongoing 1st December 2005 Page 22 5. 12 Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 6. 7. 19 19 23 12 8. 9. 19 19 26 23 23 10. 19 13 23 11. 12. 13. 19, 38 19, 38 27 23 23 12(1) 18 residents which meets their individual expectations, preferences and capabilities . The frayed carpet in chaffinch room must be made safe . Privacy locks must be fitted to the bathroom next to room 5, and doors to ensuite facilites in rooms 1 and 3. Action must be taken to ensure the bathroom door (next to room 5) closes. Remedial work must be undertaken to the laundry room which includes the sealing of the floor and repairing and repainting walls. Written confirmation must be provided which demonstrates that glazing in the conservatories meets the safety standards necessary Fire exits onto fire escapes must be alarmed. Action must be taken to ensure the door to bedroom 2 closes on its rebate . Staffing levels in the home must be maintained at appropriate levels at all times in order to ensure residents needs can be met. Written evidence must be provided to demonstrate work identified by the fire officer has been completed as required to the standard required. (previous timescale 1st June 2005 not met) Immediate 1st December 2005 1st November 2005 1st December 2005 1st November 2005 1st December 2005 Immediate Immediate and ongoing 1st November 2005 14. 38 13(4) 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 23 Tutnall Hall Nursing Home 1. 2. 3. Standard 3 19 35 It is recommended that documentation used for completing assessments is reviewed to provide more space for the detailed recording necessary. It is strongly recommended that the planned maintainence programme includes the remedial work/replacement of wooden windows as appropriate . It is recommended that monthly audits are undertaken of any monies held on behalf of residents. Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 24 Commission for Social Care Inspection The Coach House, John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tutnall Hall Nursing Home E52 S4149 Tutnall Hall V247444 140905.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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